A busy A&E department. And the secret of success is? November 14, 2016 News It was just another busy A&E in London. I was with my friend, recently diagnosed with lung cancer. We were meant to be meeting for lunch in some nice eating place; but he’d rung me from an ambulance, whisking him to hospital after he’d experienced serious and incapacitating pain in his foot. So we met in A&E, where I found him parked in a wheelchair in a narrow corridor. He was parked and left with about two feet of space between himself and the seating attached to the wall on the other side of the corridor. This left him in the way of everyone walking through the corridor or transporting equipment on wheels. I sit opposite him and we try to talk, but by the time my legs are added to the narrowed corridor, there’s no space for any sort of passing. ‘Why did they leave you here?’ I ask. He hadn’t been told; and now he was no one’s responsibility. There were a lot of staff around, a vast array, all in different uniforms…so many different uniforms passing by us. And all had their roles, wandering back and forth, heads down; though no two roles seemed to marry together in this vortex of chaotic care. ‘There’s no one here who knows what’s going on,’ I say after an hour or so. Everyone understands their particular roles; but it’s clear that no one here has an overview. ‘It’s time you were moved.’ I negotiate with one of the uniforms to move my friend out of the corridor and into an open cubicle off the corridor, by the staff coffee station. He’s in terrible pain, and has been since his arrival. He thinks it might be gout caused by the chemo. We have to stop talking sometimes because the pain is too much. After an hour and a half, I decide it would be good to find out what’s going on. (When you’re in pain, it is difficult making these decisions for yourself; your energy is focused on survival. Everyone in A&E needs a patron.) The thing is, no one has spoken to my friend since he was left in the corridor by the ambulance crew. Does anyone know he’s there, for instance? When no one has oversight, when no one is holding a space – whether school, hospital or office floor – it is easy for people to get missed. I ask one uniform if she knows anything about his status in the queue. Or whether he’s even in a queue? (This has happened on two occasions with me and my family, when we slipped into a black hole somewhere behind the reception desk…you don’t find out about the black hole until a few difficult hours have passed.) This particular uniform doesn’t know if my friend is in the queue but goes to find out… though she tells me it isn’t her job. Another uniform, though – a nice uniform – returns a while later to say he is in the queue. So after two hours in A&E, we have established that they know he’s here, which is reassuring. Perhaps there is some intelligent design behind this, after all; there is clearly a list somewhere, in some clinical holy of holies – and a list at least means order, if not care. After two and a half hours of pain, a blood test is taken, and then, a short while later, like an oasis in the desert… a doctor appears. A doctor! Ta-da! ‘It’s pathetic how grateful you feel when you meet someone intelligent and kind in these circumstances,’ says my friend after seeing him briefly. He’s breathing more peacefully; the doctor had come up trumps; he has felt heard. ‘I envy the doctors in places like this,’ I say. ‘Look at them: regarded as such important people and always in such demand!…two things I’ve never been.’ My friend laughs. Laughter – and some discreet pestering – is my main contribution to his afternoon in this hierarchical but leaderless vortex of well-meaning and chaotic care. Four hours after my friend’s arrival, I put him in a taxi home. I’ve been to the pharmacy for his drugs and the nice uniform has given him some crutches. ‘How do these work?’ he asks, toppling backwards. We give him crutch lessons, though I last used them when I was eleven…it’s like riding a bike, though, you never forget. Most people I know who work in A&E enjoy the adrenalin rush of constant crisis; there’s a buzz to it, which I understand. But while they are getting their buzz, there’s also the patient. And from the patient’s point of view, communication is important. Everyone knows they must wait; but it’s easier to wait if you know what’s happening, if you’re kept informed… if, in some manner, you feel held. Unknowing is fine for the healthy; but for those in pain, in crisis, in difficulty, unnecessary unknowing is simply careless. And my friend was in great pain for two hours before anyone acknowledged his presence. All A&E’s are a glory, a miracle, this is well known; a tribute to this country’s wonderfully-conceived NHS. But miracle, like everything else, is on a continuum. And probably the three factors which most shift the miracle to the beautiful end of the continuum are correct diagnosis, appropriate treatment…and communication. ‘This is what’s happening,’ are healing words in life – and cost nothing.